Background:
Previous reports indicate many patients with advanced cancer continue preventative medications (PMs) of uncertain/no benefit despite limited life expectancy, increasing risk of polypharmacy-related adverse events and healthcare burden. By time of palliative care unit (PCU) admission, discussion around deprescribing of PMs would be appropriate.
Methods:
Retrospective review of medical oncology admissions to PCU at a single institution between August 2020-May 2024. PMs based on established literature were (i) lipid-lowering agents, (ii) anti-hypertensives, (iii) aspirin (for primary prophylaxis), (iv) anti-resorptive medications (for osteoporosis) and (iv) vitamins. Admission pharmacist home medication reconciliation (either PCU or the directly preceding acute admission if transferred) was reviewed.
Results:
Of 888 eligible patients we randomly sampled 100 patients, median age 64 years. Lung (n=22) and colorectal cancer (n=12) were the most common diagnoses. Admission was at a median of 14 (IQR 8-39) days prior to death. Patients were prescribed a median of 12 (IQR 9-16) home medications, with 69 prescribed PMs, most commonly vitamins (49%) and anti-hypertensives (33%). Patients prescribed PMs were older (69 vs 53 years; p=<0.01), more co-morbid (Charlson Co-morbidity Index 7 vs 6; p=0.04) and experienced more polypharmacy (14 vs 10 home medications; p=0.02). Outpatient palliative care involvement (p=0.82) and time from last systemic treatment (p=0.29) were not associated with PM use. 88% (61/69) had PMs ceased during admission, including 27 of 46 (59%) during acute ward admission (prior to PCU transfer). Patients prescribed PMs were no more likely to discharge home (p=0.21). Time from last systemic treatment to death was 69 days (IQR 29-139) for those on PMs.
Conclusion: Within weeks of death many oncology patients remain on PMs, typically ceased during their last acute hospital or PCU admission. This data suggests earlier opportunities to discuss appropriate deprescribing are being missed in many patients from the time systemic therapy is discontinued.